SMART LIVING WITH GENITAL HERPES
by Dr. H., Medical Director
www.herpes.org
updated December 1, 2006
Living with genital herpes as a chronic health condition is a relatively straightforward process. And while outbreaks can certainly be a nuisance, it is the individual's outlook on life and degrees of fatigue, anxiety, and stress that can complicate the management of the virus.
The message of this paper is that through some basic education and awareness, people with genital herpes can feel more at peace with the condition as they achieve excellent control of the disease, avoid spreading it elsewhere on the body, prevent family members from catching it, and significantly lower the risk of transmitting the infection to their partner.
The Natural History of Genital Herpes
The natural course of genital herpes seems to be one of getting better with age. This occurs probably due to "advancing calmness" or decreased life stress as years go by. As people get older, relationships become more solid, kids grow up, the mortgage gets paid off, debt is reduced, and general satisfaction with life increases. This lessening of life stress seems to decrease the stimulation to whatever it is that triggers recurrences.
The Triggering of Recurrences
Whatever triggers recurrence seems to be activated, in part, by emotional stress. Though no studies have been done specifically regarding Herpes, numerous studies have solidly demonstrated a link between chronic psychological stress and weakened immune function. And a weakened immune system would logically make a person more prone to having viral outbreaks. Thus the reduction of stress can definitely benefit the individual with genital herpes (see the section on Stress below).
So, WHAT is "Smart Living"?
It is known that patients benefit from a "whole life" approach to managing genital herpes. This begins with understanding what is known about treating recurrences and incorporating this into managing the disease.
Smart Living begins with the patient learning to watch themselves closely for symptoms and to treat them promptly. Evidence is clear that as many as 80% to 90% of people that are infected with HSV do not have outbreaks. However, 60% of these people without obvious outbreaks do have SOME symptoms.
Smart Living means to shower at least daily, maybe twice daily when symptoms are present, and to wear clean clothing that is changed regularly. Additionally, washing your hands regularly after any contact with areas where outbreaks occur is essential.
Blisters that occur during outbreaks should be broken in the shower using a clean wash rag with plenty of warm soapy water. Once the wash rag is used on the rash however, it should not be used further, and should be sent through a hot soapy cycle in the washing machine before using again.
Once the blisters are broken, they should be cleaned with alcohol, once on the first day and once on the second day. **This applies ONLY to external blisters, NEVER internal blisters. Though this process will produce some pain, alcohol kills fresh virus and sterilizes the wound, decreasing the likelihood of a secondary bacterial infection. If using alcohol is too uncomfortable, soap and water is acceptable for use and is nearly as effective.
After the lesions have been cleaned, they should be covered with a small amount of absorbent material, such as Kleenex or toilet paper. The tissue absorbs wound fluid and keeps it from spreading elsewhere, and should be changed two or three times a day. Also, if "hospital-type" alcohol pads are used to clean the area, then the pad can be left on the external lesion, absorbing any liquid from the lesion during the day, and removed in a warm shower later in the day. Some women use a feminine hygiene pad for this purpose, especially when the lesions are internal.
Prescription Medications
Genital herpes is very well controlled in most patients using anti-viral medications. Three medications are available: Acyclovir, Valtrex, and Famvir. Other prescription medications can be used in patients in the rare instance that their virus is resistant to these drugs.
New evidence has shown that the use of Valtrex, and possibly other anti-virals such as Acyclovir, dramatically diminishes viral shedding and MAY prevent, or decrease transmission of the disease to partners. Thus people with genital HSV should consider being on antiviral medication if they are in intimate relationships.
Topical acyclovir (Zovirax) can also help some people with oral Herpes lesions (or cold sores). A newer preparation, Denavir, has also recently been approved by the FDA for this use.
Fatigue
When someone gets tired, the body has to work harder to keep going. This means that the "gas pedal" of the body, or Adrenalin, is driving the body harder and this makes the nervous system work harder. The genital herpes virus lives in a small part of the nervous system at the bottom of the spinal cord called the "ganglia". Since the virus is part of the nervous system, when the nervous system is stressed by fatigue, viral activity can increase and outbreaks can occur.
A Smart Living person would seek to maintain a proper sleep cycle, getting about eight hours of restful, non-chemically-modified sleep. Practical suggestions for improving sleep are available in many magazines, books, and on the internet. For a helpful summary, please see this helpful paper at Family Doctor.ORG.
Stress
Most people experience more frequent outbreaks in association with "deep stress" when intense emotions such as anger and fear are triggered. Difficulties in family or romantic relationships, interpersonal conflicts at the job, or significant worry about finances are examples of these "core level" stresses.
People with recurrent Herpes infections must better manage this type of stress. While no one can remove stress completely, individuals can learn to react to stress differently. There are many resources available regarding stress management including counseling, support groups or talking to a trusted friend or family member. Specific interventions for stress management may include journaling, meditation, relaxation techniques, spiritual work, physical exercise, and eating better. No single approach to stress management is right for everyone so we encourage you to explore the vast amount of books, CDs, DVDs, and workshops available on the topic.
There also may be concrete steps that a person can take to resolve specific stressful situations. These may include leaving a relationship where you are not being treated well, talking to a supervisor regarding a work conflict, or refinancing a house to reduce financial stress.
It is important to address another stress which can occur in those with Herpes. Unfortunately in our society, there still exists a stigma associated with the virus. Thus many people with Herpes, especially soon after being diagnosed, feel shame and embarrassment. Others fall into a depression and wonder if anyone will want to be with them sexually again. We encourage anyone having these feelings to talk to a counselor, friend, or attend a Herpes support group. These feelings are a normal initial reaction and most people find that their biggest fears about the virus are actually unfounded. Eventually, the virus becomes something to manage, like any other health condition. For a more detailed look at these issues, please see The Psychology of Living with Herpes.
Tight Clothes
Many people with herpes have found that tight clothing, especially tight undergarments, can stimulate recurrences. It is reasonable for the person suffering with frequent recurrences to at least make sure that garments in the pelvic area are not constricting.
Ultraviolet Light
Ultraviolet (UV) light exposure (from the sun or tanning salons) is known to re-activate oral herpes infections. A Smart Living person would then avoid UV light exposure, or use a sunscreen of Factor 25 or higher on the face prior to UV exposure. People with genital Herpes recurrences would also be advised not to sun-bathe in the nude or use tanning beds nude.
Diet
Some people tend to benefit from diets with elevated lysine levels and decreased arginine levels. Research in this area is inconclusive however increasing lysine intake may be helpful to some people. Foods high in lysine are milk, soybeans, and meat. Lysine supplements are also available at any health food store.
Many people have food allergies or allergies to the chemicals in personal care products resulting in skin rashes. It would be reasonable to attempt to control these allergies so that the patient's skin is not irritated. Some people have increased outbreaks due to excessive amounts of alcohol and/or caffeine. Progressive withdrawal of either or both might be reasonable in a patient with frequent recurrences.
Dietary Supplements
Many herbal products have been shown to have properties that may benefit some people with herpes infections. Natural products known to have anti-viral effects include: red marine algae, olive leaf extract, melissa, garlic, and a certain cactus called "opuntia streptacantha" also released as Exanol by www.henderson-morley.com.
Immune system stimulating herbs include echinacea and astragalus and have seemed to benefit many people with both genital and oral herpes.
Topical Preparations
Certain chemicals and natural preparations have been shown to be antiviral. These include rubbing alcohol, various essential oils, and lemon balm. A useful site for more details is www.forces-of-nature.net.
Intimacy between Partners with Herpes
In any sexually intimate relationship, either one or both partners may have Type 1 (oral) or Type 2 (genital) herpes or both. Even when couples both have the virus, they may carry different strains and thus could pass that different strain to their partner. Thus, in any of these situations, the precautions are the same.
Herpes infections occur when the virus is transmitted through a broken area of the skin. Recurrences occur in the same place where the virus first broke through the skin or in other areas served by the same nerve cell.
Firstly, it is advised that partners do not have sexual intercourse, oral sex, or any skin to skin contact with the affected area when a partner is having symptoms. However, any area of skin that has ever been infected with herpes has the possibility of shedding virus even when there are no symptoms present. And it is impossible to know when someone is having this "asymptomatic shedding". Please see the paper on Asymptomatic Shedding for more information. Thus a person who has unprotected vaginal or anal sex or performs oral sex on another person with genital herpes can at anytime catch the infection. Important information regarding ways to obtain closeness and arousal can be found in our recent paper, Alternatives in Intimacy.
In addition, more than 70% of Americans have oral herpes infections (or cold sores around the mouth) that are active but not obvious and which can be transmitted to the genitals of the partner. Thus someone who has recurrent cold sores should use caution regarding performing oral sex upon a partner.
A man can wear a latex condom which should, if it remains unbroken, prevent transmission of oral herpes infections to the penis or genital herpes to the mouth, vagina, or anus. The condom however, does not protect the scrotum, fingers, or other areas of the male partner's body if the female is the infected partner.
A woman can use the Female Condom, a "Dental Dam", or place Saran Wrap over the vaginal/clitoral area to prevent either transmitting virus to the mouth of the partner if she has genital herpes, or to the vaginal area if the partner has oral herpes. Another alternative for women is to cut a latex condom lengthwise and use it to cover the vagina and clitoral area.
The condom should be latex, not "lambskin", which is porous (leaky) on a microscopic level. For those with latex allergies, polyurethane condoms (Avanti is the one brand) may be used instead. Also, the condom should be lubricated, so that friction is diminished. Spermicidal lubrication should be avoided since it can cause irritation of the skin which actually encourages viral transmission.
Both men and women may also wish to wear latex or polyurethane gloves when manually (by hand) stimulating their infected partner's genital or anal area.
Avoiding very aggressive intercourse is also recommended as vigorous thrusting can create small tears in the genital tissue which allows for transmission of the virus.
Finally, as mentioned above, consideration should also be given to the partners being on anti-viral medication to prevent virus transmission.
For additional details on precautions, please see Alternatives in Intimacy.
The Future
Vaccines may one day be available to prevent uninfected partners from catching an infection. Vaccines may also help people decrease or eliminate recurrences of the infections.
Currently, an investigational vaccine "Herpevac" is being developed and researched to help stop transmission of genital herpes. It has passed preliminary testing for safety and effectiveness and is now in its final phase of clinical trials (with women subjects only). For details and study sites, please see http://www.niaid.nih.gov/dmid/stds/herpevac/studyover_faqs.htm
Finally, another excellent resource to read about Smart Living can be found at Terri Warren's wonderful website, Westover Heights.COM .
For any other questions, contact Dr. H at HERPES.ORG
THIS PAPER WILL BE UPDATED AT PERIODIC INTERVALS AS SCIENTIFIC LITERATURE, APPROVED THERAPIES, AND FEEDBACK FROM USERS OF THIS SITE SUGGEST NEW INFORMATION THAT SHOULD
BE CIRCULATED.
HERPES.ORG DOES NOT PURPORT TO ESTABLISH A PHYSICIAN-PATIENT RELATIONSHIP. ALL TREATMENT DECISIONS SHOULD BE MADE BETWEEN A PATIENT AND HIS/HER PRIVATE PHYSICIAN. NO TREATMENTS SHOULD BE ATTEMPTED WITHOUT A FIRM AND CONVINCING DIAGNOSIS OF THE CONDITION BEING TREATED.
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